July 2011, $5.95
Better business for dentists
The link between orthodontics and forensic odontology in Darwin, page 14
How one family worked out the best way to keep their practice together and have a life at the same time, page 24
Print Post Approved no: 255003/07512
Tools of the trade: Getting a grip on the best grip; doing dentistry with a touch of salt, and much, much more …
In the driver’s seat
SPECIAL REPORT: PRACTICE MANAGEMENT SOFTWARE
Everything you need to know about practice management software, starting on page 32
The business benefits and design challenges of setting up a pratice in an unusual location
The need for speed
Dr Ian Young and the fastest dentist on the Sunshine Coast! Page 42
Dr Hugh Fleming’s mastery of technology has halved the time taken to create implant placement plans
14. Looking for clues
The time machine Dr Hugh Fleming explains how a mix of techno tools has staged a diagnostic breakthrough Cover photograpph by Richard Birch
Northern Territory orthodontist Dr Mark Leedham has found an interesting (and beneficial) way to enliven his practice— forensic odontology
Your business 24. A balancing act Getting a balance between work and family is a challenge, but this Melbourne dentist and her family have the right idea
28. Odd spots
Editorial Director Rob Johnson Sub-editor Kerryn Ramsey Contributors Sharon Aris, Nicole Azzopardi, Kerryn Ramsey, Lucy Robertson, Maureen Shelley, Gary Smith Creative Director Tim Donnellan Commercial Director Mark Brown For all editorial or advertising enquiries: Phone (02) 9660 6995 Fax (02) 9518 5600 email@example.com Suite 4.08, The Cooperage 56 Bowman Street Pyrmont NSW 2009
7,714 - CAB Audited as at March, 2011
Bite magazine is published 11 times a year by Engage Media, ABN 50 115 977 421. Views expressed in Bite magazine are not necessarily those of the publisher, editor or Engage Media. Printing by Superfine Printing.
Setting up your practice in a non-traditional location offers both design problems and opportunities—which can also be good for business
Your tools 32. Practice management software guide Everything you need to know about practice management software, which will make your practice more efficient and more profitable
12. New products
08 News & events 05. Vic supports research The Victorian government is handing out grants for dental research. ALSO THIS MONTH: A New Zealand politican has devised a plan for free universal dental care; new studies may offer future treatments for dry mouth; Wrigley is handing out money; DNA tests may prevent gum disease in the future; and much, much more …
The latest and greatest gear including dental units from WIlliam Green and new software from Ivolcar Vivadent
39. Tools of the trade
Get to grips with the best grips; a rubber dam everyone can love; and learn the magic anti-gagging properties of table salt (and more) this month
Your life 42. Passions
Dr Ian Young of Sunshine Coast makes dentists faster for one day of the year
39 Bite 3
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Victoria supports dental research The Victorian government is funding research into improving the population’s oral health
Kiwi politician pushes for free universal dental care
The Victorian government is putting up money for research into oral health.
he Victorian Health Minister, David Davis, last month launched the inaugural Dental Health Services Victoria (DHSV) Research and Innovation Grants Showcase. The event showcased 10 research projects funded by DHSV to improve the oral health of the population. The Minister said, “The DHSV Research and Innovation Grants Program is a key part of the work to improve the oral health status of Victorians and I believe it will pay long-term dividends.” The Minister’s presence at the showcase was appreciated by public oral health professionals who witness first-hand the burden of poor oral health on Victoria’s vulnerable population. The new CEO of DHSV, Dr Deborah Cole, stressed the importance of research in improving oral health. “It is important that we have a strong evidence base to support the clinical services that we provide, and we need to continually be finding better ways to improve oral health,” she said. “The Research and Innovation Grants Program is one of the steps DHSV is taking to build that evidence base.” The 2011-12 State Budget has allocated funds to improve the oral hygiene
of children between up to three years of age and encourage dental practitioners to relocate to country areas. The Minister highlighted these initiatives, while acknowledging that there is a lot more work to be done. “I believe this investment will help, and I say no more than help because I am not under any illusions about the challenges we face in delivering dental services across the state.” The Minister also took the opportunity to launch the Department of Health’s new evidence-based oral health promotion resource—a practical summary for policy development and program implementation. Following the Minister’s address, the recipients of the DHSV Research and Innovation grants shared their project outcomes with the attentive audience of academics and health industry professionals. The findings highlighted the importance of integrating oral health promotion into the general health sector as well as the need for the health system to respond effectively to Australia’s increasing and ageing population. For more information on the DHSV Research and Innovation Grants Program, please go to www.dhsv.org.au.
While the debate continues in Australia as to the type of dental care the government should fund, a New Zealand politician has proposed a free universal dental care scheme. Jim Anderton, Progressive leader and member for Wigram, said the scheme would cost around $1 billion a year at current prices. “The required funding could come from a levy on income, similar to ACC (Accident Compensation Scheme) levies, a reduction in the $17.8 billion tax cuts given to the most affluent New Zealanders by the National-led government over four years (average $4.4 billion per year), a levy on sugary soft drinks because of their contribution to the forthcoming diabetes epidemic, or a mix of all these possible sources of funds,” Mr Anderton said. His plan advocates free dental care should be extended over time, and on an incremental basis, to all New Zealanders. First to the most vulnerable groups; pregnant women, those aged 65 years and over followed by those aged between 18 and 28, then those 28 years to 50, followed by those between 50 and 65 years old. The policy initiative was welcomed by New Zealand Labour party health spokesman Grant Robertson, telling a local newspaper it was a useful tool in improving overall dental health care. “We know many New Zealanders are not receiving the dental care they need. A recent nationwide survey showed that 44 per cent are not receiving any at all,” Robertson said.
06 News from our partners Professor Fridus van der Weijden’s Lecture Tour We are all aware of the importance of a more holistic approach to dentistry than just drill and fill. MI dentistry represents one such facet.
isiting Periodontist from The Netherlands ACTA University, Professor Fridus van der Weijden has dedicated 25 years of his career to evaluating and researching oral hygiene products’ efficacy and safety. He has researched extensively on flosses, interdental cleaning, mouth rinses, electric toothbrushes and ultrasonics and has over 160 international publications to his credit including several systematic analyses. In May, he was a guest of the University of Queensland, ADANSW, ADAVB and DHAASA where he toured Brisbane, Sydney, Melbourne and Adelaide to lecture on the Safety and Efficacy of Electric Toothbrushes and the Power of Ultrasonics. Professor Fridus shared that a lot of progress has been made in both the fields of electric toothbrushes and ultrasonics. Electric brushes have been around for about 50 years but for a long time, there was no scientific evidence that it was any more efficacious then manual toothbrushes in removing plaque. Since the late 1980’s Professor Fridus have tested and researched into various electric toothbrush technologies. The last two decades saw the growth in popularity of two distinct technologies, one with oscillating-rotating brush head motion (eg., Oral-B Triumph, Oral-B Vitality) head and the other with side-to-side motion (eg., Oral-B Sonic Complete, Sonicare Flexcare+). The oscillating-rotating technology has been more researched and evaluated than any other technology. In 2005, the internationally respected Cochrane Collaboration concluded in its systematic
Professor Fridus van der Weijden
analysis that “when compared to manual toothbrushes, powered toothbrushes with an oscillating-rotating action provide protection against gum inflammation in the long and short term and better plaque removal in the short term. No other powered designs were as consistently superior to manual toothbrushes.” According to Professor Fridus, it is well documented that the average brushing time for most people is about 45 sec. In 1993, he published a comparative study on the effectiveness of plaque removal in relation to brushing duration. Three electric toothbrush technologies were investigated in comparison to manual toothbrush. He concluded that 2 mins of brushing with an oscillating-rotating electric toothbrush removed more plaque than 6 mins of brushing with a manual toothbrush. Since then, it has become an industry
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standard that 2 minutes of brushing is the recommended minimum. On the issue of safety, professor Fridus’ systematic review of 35 studies published in the Journal of Periodontology (2011) concluded that electric toothbrushes with an oscillatingrotating technology are as safe as manual toothbrushes. It is interesting to note that on average, people who use manual toothbrushes exert about 100g more force than those using electric toothbrush. Many electric brushes today also feature mechanisms to prevent too much pressure being applied on the brush head. Professor Fridus also runs a thriving specialist private practice limited to periodontics and has 3 associate Periodontists and 12 hygienists in his team. He also shared his thoughts on the importance of hygienists in his practice and without them, he would not have been able to focus on the areas of dentistry that he is most passionate about. Besides, he feels hygienists are specially trained to clean teeth they often can do a better job. He also gave a tip on practice marketing. For every new patient his practice sees, they receive an electric toothbrush at the first appointment. He said that new patients are very eager to talk to their friends and family about their new dental experience, both good and bad experience. By surprising them with an electric toothbrush, it is not just about goodwill and marketing but more about showing his care for the patients well bring. To read some of his publications, please log onto: www. bitemagazine.com.au/oralB. £
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Recommend Sensodyne iso-active to: ✔ The 1 in 3 people who suffer sensitivity 4 ✔ Sensitivity sufferers looking for an innovative delivery system ✔ Who are not currently treating their sensitive teeth
www.gskoralhealth.com.au References: 1. Gross RC et al. Presented at the General Session and Exhibition of the Pan European Federation of the International Association for Dental Research (PEF IADR) 2008, September 10–12. London, England. Poster 467. 2. Hall PJ et al. Presented at the General Session and Exhibition of the Pan European Federation of the International Association for Dental Research (PEF IADR) 2008, September 10–12. London, England. Poster 466. 3. Leight RS et al. J Clin Dent 2008;19:147–53. 4. Addy M. Int Dent J 2002;52:367–75. For the relief of sensitive teeth. Sensodyne® and iso-active® are registered trade marks of the GlaxoSmithKline group of companies. GSK0102/UC *Compared to a regular marketed toothpaste containing 5% potassium nitrate. Sensodyne® contains potassium nitrate.
exhibiting dental industry excellence
09 Looking for new patients?
News bites Beating dry mouth
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Researchers from the US’s University of Louisville are one step closer to helping millions of people whose salivary glands no longer work because of disease or damage from treatment of diseases. The scientific finding of Professor Douglas Darling, PhD, of the Department of Oral Health and Rehabilitation, Help is at hand for UofL School of Dentistry, those who suffer from Sjogren’s syndrome and his team identified a protein sorting mechanism used by the salivary gland. The National Institutes of Health-supported study was published online recently in the Journal of Dental Research. The scientific discovery could form the basis for advanced therapies for patients whose salivary glands are damaged or no longer function due to radiation therapy, prescription drugs or Sjogren’s syndrome. The salivary glands are essential for lubrication, defense and beginning digestion in the mouth. The largest of the salivary glands—the parotid—secretes important proteins into the saliva. As with all salivary glands, it has multiple secretion pathways, therefore it must sort proteins destined for saliva into the correct pathway for secretion. This can be tricky as there are seven possible pathways. One pathway takes proteins to the salivary duct, other pathways carry different proteins to the ‘back’ side of the cell to be secreted into the blood or to form a supportive matrix for the cells. Transport along these pathways occurs by sorting the proteins into vesicles (hollow membrane sacs) that carry their ‘cargo’ to the correct destination. Conventional thought was that cargo proteins are moved into the forming vesicles by attaching to sorting receptor proteins. Darling and his team have discovered a completely new approach, suggesting the reason no salivary sorting receptor protein has been found is that it may not exist. In Darling’s new model, the salivary cargo protein, parotid secretory protein (PSP), selectively and directly binds to a rare lipid, a type of fat molecule called PtdIns(3,4)P2, present only in certain cell membranes— and only present on one side of the membrane. Darling also found PtdIns(3,4)P2 can flip to the inner part of the vesicle membrane—giving PSP the opportunity to bind it. “These data imply that phosphatidylinositol-phosphate lipids like PtdIns(3,4)P2 may have multiple functions on the inner surface of organelles,” Darling said. “This is contrary to the current belief that their functions are always limited to one surface of the cell membrane.”
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10 News bites DNA testing to prevent gum disease
Wrigley offers research awards
A new study that will attempt to use DNA to detect and predict the risk of gum disease has been commissioned in the USA. The breakthrough research, to be conducted by the University of Michigan’s School of Dentistry, alongside a third-party health company, will take place over the course of one year and collect genetic information from around 4000 people. Should positive results arise from the test, they could prove very important for the preventative care in fighting serious oral health complications. The issue of DNA testing has proved controversial in recent years. Tests now exist that can detect common disorders such as diabetes and heart disease, but many people fear discrimination by insurance companies. People in the USA are already protected by The Genetic Information Nondiscrimination Act of 2008, which prohibits discrimination on the basis of genetic information with respect to health insurance and employment. Researchers will also examine rates of tooth survival against what kind of dental treatment plans people have. All these results will give the researchers enough precious data in order to see how they correlate.
In global partnership with the International Association for Dental Research (IADR), the Wrigley Salivary Research Award returns in 2012 for the third consecutive year. Hamish Thomson, managing director Wrigley (Pacific), said: “The Salivary Research Award creates opportunities for Australian and New Zealand dental students and professionals to showcase their work on the world stage, providing not only financial assistance for future projects, but unprecedented opportunities to present before global peers and thought leaders. All aspects of salivary research are considered: from oral health to functions and properties of individual protein, and salivary diagnostics,” said Mr Thomson. Part of Wrigley’s EXTRA® Oral Healthcare program, the scheme awards two clinical research grants of $US1,500 each; and one general research grant at $US2,000 each year. These grants are utilised to fund attendance and travel costs to the 90th IADR General Session and Exhibition in Rio de Janeiro, Brazil (June 20-23, 2012). To qualify, dentists, dental scientists and dental students must be currently involved in a body of research. Find out more at www.iadr.org/SRGResearchAward.
12 New Products New-release products from here and around the world
Cementation Navigation System
Ketac™ Nano Light-Curing Glass Ionomer Restorative Quick Mix Capsule Excellent Aesthetics and Innovative Design in a Single Quick Mix Capsule. 3M ESPE is pleased to announce - Ketac™ Nano LightCuring Glass Ionomer Restorative Quick Mix Capsule is now available in Shade A4. Ketac Nano Light-Curing Glass Ionomer Quick Mix Capsule demonstrates outstanding wear resistance, aesthetics and polish, while offering high fluoride release similar to conventional and resin-modified glass ionomer restoratives. The product’s unique bonded nanofillers and nanocluster fillers, along with fluoroaluminosilicate glass, provides better aesthetics than traditional glass ionomers, while still providing the same benefits. Each Quick Mix capsule contains a convenient unit dose of Ketac Nano. To prepare, simply lift the nozzle on the capsule, insert it into an applier, and slowly syringe the product. The revolutionary Quick Mix Capsule mixes the two pastes inside the tip, and the material can be dispensed directly into the preparation. Ketac Nano Light-Curing Glass Ionomer is indicated for: Primary teeth restorations Small Class I restorations Class III and V restorations Transitional restorations Laminate/sandwich restorations Core build-ups For further information, please visit www.3MESPE.com.au, or contact 3M Customer Service on 1300 363 454.
The Cementation Navigation System is a new multimedia application from Ivoclar Vivadent. It offers dentists practical orientation and guidance in the selection of the best luting material for each case. Dental professionals can choose from a wide variety of materials when it comes to the fabrication and cementation of indirect restorations. Frequently the ideal combination for each case is difficult to find. The Cementation Navigation System offers dentists straightforward guidance in the selection of cements and helps them identify the optimum solution. Detailed animations provide comprehensive information on the application of the material chosen—right from the removal of the temporary restoration to the final fluoridation procedure. The Cementation Navigation System can be accessed via the internet at www.cementation-navigation.com. For further information, contact Kim Chew on 0400 515 260 or email firstname.lastname@example.org.
Opti 1 Step Polisher Enhanced polishing results for composite restorations. Smooth surface and high gloss, in just one step Increases surface gloss Eliminates scratches on composite restorations Reduces surface roughness and bacterial retention Delivers comparable results to multi-step systems and procedures Perfect control of abrasiveness on all surfaces due to optimised flexibility Allows a variable abrasion by changing pressure Gold-plated mandrel and unique abrasive matrix for greater durability Autoclavable, reusable More cost efficient compared to traditional procedures. Visit kerrdental.com or call 1800 643 603 or Sydney (02) 8870 3000 for more information.
Your world Forensic odontology
Article Rob Johnson
Looking for clues Northern Territory orthodontist Dr Mark Leedham has found an interesting (and beneficial) way to enliven his practice—forensic odontology
nowledge is a problem in forensic odontology. It’s a problem because, with so few qualified odontologists around, it’s hard to justify gathering them all in one spot for professional development. But it’s also a problem because the usual way to gather them all together is to have a catastrophe, like the Bali bombing or the Victorian bushfires. Dr Mark Leedham was at both of those events. “As an unfortunate result of the Victoria bushfires and other disasters, Australian forensic odontologists are very experienced,” he says. He was involved with Task Force Phoenix, set up in the aftermath of the Black Saturday bushfires, from the beginning. “I think everybody in Australia was aware of the danger of bushfires, but no-one knew what a catastrophe it was down there,” he continues. “I got the phone call to come and help early on the Sunday morning. I flew down on the Monday evening, just as the process was getting underway. There was another crew of people who arrived within three or four days. “There’s between 20 and 25 forensic odontologists scattered around the country. We have our own society and a roster system, so at any time there’s a number of people on-call for odontology for Australia or overseas. We’re expected to be ready to go with a few days' notice. There’s no way somebody could work in situations like (the bushfires) week after week. There were two-week rosters, then we would go back to our normal practices. I went down there twice.” It’s work that contrasts sharply with Dr Leedham’s ‘day’ job, as an orthodontist in Darwin. A past president of the ADA (NT), and member of the Dental Board of Australia, Dr Leedham has 14 Bite
had an interest in forensic dentistry for many years and has been the Forensic Dental Consultant to the NT Coroners Office since 2001. “I suppose that it adds a bit of variety to my practice,” he says about his interest in forensics. “But it’s also something worthwhile for the country. It’s not for everybody but I find it satisfying to be able to assist in situations like the bushfires.” He first became interested in odontology after he met Dr
“But it’s also something worthwhile for the country. It’s not for everybody but I find it satisfying to be able to assist in situations like the bushfires.” Dr Mark Leedham
Stephen Knott from the University of Western Australia, one of the county’s leading experts in the field. “Not long after that, we had the Bali experience, and I was involved by virtue of the fact that I was based in Darwin—a number of the victims were bought here for identification. “It was confronting—at that stage I’d never seen somebody who’d been killed by shrapnel. That was a big shock to me.” There are three ways to identify victims in a disaster situation: fingerprints, DNA or dental records. In the case of horrific bushfires like those in Victoria, forensic odontology comes to the fore because teeth are among the hardest parts of the body to destroy.
In the case of horrific disaster situations, dental records are often the only way to identify victims.
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Dr Mark Leedham (second from left) in Thailand, March 2005. Also Professor John Clement (to his right), and UK and NZ dentists.
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“The most obvious roles of dentists in the process is doing post-mortem in the mortuary,” Leedham continues. “You also collect the ante mortem records and convert them to a standard format, and then another group will match the post mortem records to the ante mortem records. At the beginning the post mortem work is done, then you move to matching that information to the ante mortem. This is a well-recognised process. We use the Interpol protocols, which makes it much easier to work with other countries. In Thailand (after the tsunami), there were people from New Zealand, the UK, Japan and Europe. We all had the same plan in mind, even if some of us operated slightly differently to others.”
ustralian forensic experts like Dr Leedham and other members of AusFO (Australian Society of Forensic Odontology) are on call to perform this work throughout South-East Asia and the SouthWest Pacific. Obviously this mounts particular challenges to keeping your day-to-day practice running. “The challenge (with keeping a practice running) is you can’t predict disasters,” says Leedham. “I’m very fortunate because most of my patients know I have some involvement with this, and I can defer some treatments. But patients are very understanding, and I have a good staff. Also, there are only two orthos in town, me and Dr Jeff Swann. He’s happy to see my patients if I’m not around, so that’s reassuring for the patients. I do appreciate his help.” In October his hometown will host the Darwin Forensic Odontology Symposium (at the Crown Plaza Hotel Darwin, October 14 – 16). As a relatively small group, continuing professional development is a difficulty. “We have a forensic science meeting every two years,” says Leedham. “Unfortunately we often only meet at disasters, which is not the best time to exchange information. Australian forensic odontologists have a good reputation; also, those from Europe, the US and Canada. And unfortunately, Japan is getting a lot of experience in the field right now.” For more information on the Darwin Forensic Odontology symposium, go online to www.ausfo.com.au
offer the best care with the best equipment, why wouldn’t you? Equipment, fitout and practice assets are critical to the way in which you run your practice and care for your patients. Investec has a range of finance structures where you can select repayment options to suit your cashflow, enabling you to update your equipment now and be best placed to treat your patients’ needs. Be at the forefront of your profession. Contact your local banker, call 1300 131 141 or visit www.investec.com.au/medicalfinance.
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Your world Technology
The time A mix of techno tools stages a diagnostic breakthrough ntil about a year ago Dr Hugh Fleming had to wait as long as two weeks to get back a CT scan in order to let a patient know whether an implant was even possible. Before he could perform precisionguided surgery, the data went off to an outside party, who would do the final implant planning and build the surgical guide. That meant at least another five weeks before he could go to work. Two months and four appointments later, with the necessary data and materials finally at hand, there were still limitations. Dr Fleming, whose practice is in the Sydney suburb of Mosman, was restricted to using 2D plain films to figure out how to place the implant. In order to get a better view, the surgery usually meant raising a large flap of gum to expose the bone, not something most patients would choose. Many practices are still restricted to 2D X-rays and are forced to take a similar approach, but in Australia Dr Fleming is at the forefront of what may be a new era. He’s one of the first in this country to utilise a groundbreaking integration of the German company Sirona’s technologies and tools. Dr Fleming’s approach involves taking X-rays with the company’s 3D scanning module (GALILEOS) employing
Article Andy Kollmorgen Photography Richard Birch
a SICAT radiographic template and merging this with data from an optical scan of the edentulous space via Sirona’s CAD-CAM imaging platform (CEREC). The combined data goes into the GALAXIS implant planning software to come up with an implant placement plan that’s in line with the final restorative outcome. In many cases, a definitive restorative proposal is developed on the patient’s first visit. A SICAT surgical guide, designed specifically around this implant plan, is then ordered from SICAT in Germany with a 10-day turnaround. When it arrives, Dr Fleming is ready to perform surgery with up to a 500 micron degree of accuracy on the patient’s second visit. A provisional restoration, custom-built utilising this precision surgical guide, can be placed when the implant is placed with minimal if any adjustment. According to Dr Fleming, there is little surgical trauma or postoperative discomfort because the surgery is performed through small punch holes without raising a flap of gum. What used to take two months now takes about two weeks, and everything except the actual construction of the precision surgical guide takes place at Dr Fleming’s practice. “With this system in place, all the planning information is married together,” Dr Fleming says. “We can plan the implant treatment to the end result in front of the patient and they become part of the planning process. It also allows the patient to see the treatment a lot more clearly along with all possible outcomes, both good and bad. We then press a button and get the precision surgical
Dr Hugh Fleming in his Sydney surgery.
The combination of a 3D field of vision and a surgical tool accurate to within 500 microns at the apex has set a new benchmark in diagnostic as well as surgical precision, says Mornay Cheetham, director of Sirona’s CAD-CAM Group.
guide back in 10 days. I can make a precise-fitting provisional prosthesis prior to surgery. This factor alone saves me a lot of surgery time.” The product manufacturer has an obvious stake in calling this integration of technologies a breakthrough. But the manufacturer may have a point. The combination of a 3D field of vision and a surgical tool accurate to within 500 microns at the apex has set a new benchmark in diagnostic as well as surgical precision, says Mornay Cheetham, director of Sirona’s CADCAM Group at the Australian arm of the German multi-national.
entists have to see the bone in order to place the implant, and they’ve been doing this with 2D X-rays with varying degrees of success. Usually they have to cut through tissue to get a better look. The big breakthrough for dentists is that they will no longer have to put the patient through the trauma of a very invasive procedure,” says Cheetham. Dr Fleming has embraced the technology, but he also has considerable experience with implant surgery and prosthodontics as well as with a number of other radiological technologies that support implant planning. These are obvious assets when it comes to knowing how to get optimum results from the latest hi-tech tools. Dr Neal Patel, an avid US fan of mixing Sirona’s capabilities, has praised the technology in the Journal of the American Dental Association as well as in materials provided by Sirona, saying the 3D pictures have been a boost in getting patients over the line. “Patients are more inclined to pursue recommended therapy and treatment simply because they understand 3D. As clinicians, we
“We can plan the implant treatment to the end result in front of the patient and they become part of the planning process.” Dr Hugh Fleming
need to remember that the 2D X-ray images that we trained on are completely foreign to the vast majority of our patients. Why should we expect our patients to see and understand diagnostic information it took us the greater portion of four years of dental school to learn how to read?” Dr Fleming agrees the upgrade has changed the implant consultation, but he acknowledges the upgrade has involved “not insignificant financial outlays. The technology won’t pay for itself through the charge-out rate for a CBCT scan alone,” Dr Fleming says, “but it will earn its keep through its enhanced diagnostic capabilities in many other areas of dentistry, and through a higher rate of treatment acceptance and streamlined surgical planning in general.” He points out that other practitioners looking to improve efficiency should make sure the set-up is a good fit for their practice. “Just because it’s the latest and greatest piece of technology doesn’t mean we should all jump on the bandwagon,” Dr Fleming says. This was hardly an impulse buy. Dr Fleming has been using Sirona’s CEREC technology for about 15 years and
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A combination of analgesics that work in different ways – like paracetamol and codeine may be beneficial.
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Paracetamol/codeine combinations have been clinically proven in post-operative dental pain4–6
Several clinical studies have provided evidence of effective pain relief when paracetamol is combined with a low codeine dose.4–6 In a study of patients who had undergone surgical removal of impacted third molars, paracetamol + codeine phosphate (500 mg/15 mg tablet x 2) [e.g. Panadeine Extra] provided significant improvement in post-operative pain relief over paracetamol (500 mg tablet x 2) alone (p=0.03), with no significant difference in side effects over 12 hours.4
...there is a significant improvement in postoperative pain relief following this combination [paracetamol 1000 mg plus codeine 30 mg] 4
Median change in pain intensity (cm/h)
This is because a combination of analgesics that have two different modes of action can enable an increase in analgesia whilst minimising side effects.3,4 In some patients it may be appropriate to offer a fixed-dose paracetamol/codeine combination rather than an NSAID or NSAID/codeine combination for the management of stronger pain, particularly for patients in whom NSAIDs are contraindicated.3
Figure 1: Median change in pain intensity with paracetamol + codeine vs. paracetamol alone (n=82)4
2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0
Paracetamol (500 mg tablet x 2)
Paracetamol/codeine (500 mg/15 mg tablet x 2)
Adapted from McCleod et al. 2002 4 Another study (n=139) compared the efficacy of a single tablet of either paracetamol/ codeine phosphate (300 mg/15 mg), paracetamol/codeine phosphate (300 mg/30 mg), floctafenine (400 mg) or placebo for the relief of pain following dental surgery.6 All three treatments were significantly superior to placebo (p=0.0001).6 A later study of 232 patients who underwent impacted third molar surgery, received either paracetamol + codeine phosphate (500 mg/8 mg x 2 tablets) taken every 4–6 hours or the NSAIDs etodolac (200 mg x 2 tablets taken every 6–8 hours) or diflunisal (250 mg x2 tablets taken every 8–12 hours).5 All three drugs were found to be effective in the control of post-operative pain.5
So the next time a patient requires proven relief from dental pain – consider recommending Panadeine Extra
BROUGHT TO YOU BY THE MAKERS OF PANADEINE® EXTRA IN THE INTEREST OF THE QUALITY USE OF MEDICINES. Panadeine® Extra contains paracetamol 500 mg and codeine phosphate 15 mg. Use: For the temporary relief from moderate to severe pain. Contraindications: Hypersensitivity to any ingredient in the product; children under 12 years. Dosage: Adults and children 12 years and over: 2 caplets every 4–6 hours orally with water; (maximum 8 caplets in 24 hours). Precautions: CNS, respiratory depression; high doses, prolonged use; renal, hepatic Impairment; poor CYP2D6 function; pregnancy, lactation. Adverse reactions: Dependence; Impairment of mental & physical abilities; nausea, vomiting, constipation; dizziness, drowsiness. Interactions: Anticoagulants; sedatives, tranquilisers; drugs affecting gastric emptying; chloramphenicol; hepatic enzyme inducers; CYP2D6 inhibitors. Please review full Product Information (PI) before recommending Panadeine Extra. The full PI is available from GlaxoSmithKline Consumer Healthcare on request (FREECALL 1800 028 533). Panadeine® and the Panadeine Vibration™ are trade marks of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare. 82 Hughes Avenue, Ermington, NSW 2115. 1800 028 533. GSK0164/BIT/UC References: 1. Hargreaves K, Abbott P. Aust Dent J 2005; 50(s2): S14–S22. 2. Beaver WT. Am J Med 1984; 77(3A): 38–53. 3. Oral and Dental Expert Group. Therapeutic Guidelines: Oral and Dental. Version 1. Melbourne: Therapeutic Guidelines Limited; 2007. 4. Macleod G, et al. Aust Dent J 2002; 47: 147–51. 5. Comfort MB, et al. Aust Dent J 2002; 47: 327–330. 6. Bentley K, et al. Curr Ther Res 1991; 49: 147–54.
has been closely following the developments that have made the use of combined 3D imaging and pinpoint surgical guidance possible. Whatever the long-term payoff, it has offered some undeniable advantages from day one. “What is unique here it that we have the ability to merge these two technologies—CEREC Cad Cam with GALILEOS CBCT—without utilising outside parties.” Even better, outside parties are referring patients to him for implant planning, and the quicker patient turnaround has freed up his appointment book for other procedures. It also addresses a longstanding frustration of Dr Patel’s. “At times we find ourselves scratching our heads when trying to formulate the ideal treatment plan for a given clinical finding, and are unable to do so simply because we do not have enough information,” he says. The company’s promotional images promise an exponential increase in information—something like the difference between a cheap magnifying glass and a high-powered 3D microscope. In the hands of a skilled and experienced practitioner, this mix of technologies could be a significant step forward for practices of many types—and it may in fact open up a new era of dental surgery. As Dr Fleming puts it, “We now have a complete 3D volume of data which can be used in a number of ways.” As with all emerging technologies, the challenge will be learning to make the most of its potential.
Dr Fleming has been using this combination of technologies for some time, making implant planning faster and more efficient.
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Your business Work life balance
Article Jodie Thomsom
A balancing act Getting a balance between work and family is a challenge, but this Melbourne dentist and her family have the right idea
ith three children, a growing dental practice and two working parents, finding a balance between work and life was always going to be hard for this Melbourne family. Malaysian-born dentist Ayu Abdullah and her husband Tarmidi Ibrahim set up their dental practice three years ago, thinking it would be the solution to their work-life struggles. With a family home attached to the back of the practice, and Tarmidi working as practice manager, they figured this was the perfect way to streamline their domestic and work routines, while being their own bosses. At first, that wasn’t the case, with long hours and the pressures of starting a business eating into any family time and leaving the couple feeling stressed and exhausted. Then this year, they saw the light, and decided to pull back, set some boundaries around their work time and make life balance more of a focus. As a result, they’re happier, and work and family are running smoothly. “It’s hard to separate, but I have to keep reminding myself, this is my life,” says Dr Abdullah. “Now, we are starting to be human again.” The need for balance This family’s experience highlights the challenge all workers face, especially those in high-pressure professions such as 24 Bite
dentistry. The long hours and stresses particular to dentistry make it hard to weave some balance into the working week, but experts warn it’s essential for maintaining emotional and physical health and happiness. It’s also a must for being a better worker. Work-life expert Emma Grey, of Work Life Bliss, says a lack of balance can lead to a range of problems, at home and at work.
“I was picking them up late from school, and had the principal saying we couldn’t do this any longer. I started to get sick, with low thyroid problems.” Dr Ayu Abdullah, Melbourne
“Something eventually gives,” she says. “Sometimes it’s health, physical or mental, sometimes it’s important relationships or performance at work. A warning sign is feeling as though you’re living your life ‘fast’, not ‘deep’.” Getting some balance brings benefits like efficiency and improved concentration at work. “People who have that work-life balance are more organised, focused and energised,” Grey says. “They also suffer less guilt over the competing demands of work and family.” Dr Abdullah says there were many signs she was suffering
The trick to achieving worklife balance is creating 'me' time.
because of overwork and lack of family time or downtime. “The harder we worked, the more we got stressed,” she says. When they first started the clinic, they were seeing patients up to seven days a week, keen to build the business and pay off the considerable start-up costs. “I didn’t know how we were going to pay everything back and were mostly working seven days a week. We don’t have anyone to help us in the house, so everything, the washing and cooking, minding children, we do together,” Dr Abdullah says. It was tough too on their children, now aged 13, 14 and 19. “I was picking them up late from school, and had the principal saying we couldn’t do this any longer,” she recalls. “I started to get sick, with low thyroid problems.” This was the turning point for Dr Abdullah and her family and they decided to make some changes.
People who have balanced their work and life are more organised and focused, and this picture doesn't make them feel guilty.
The work-life juggle The real secret to achieving a bit of balance in your work and domestic lives is to build in some ‘me’ time. For dentists, that means taking a look at your weekly schedule and booking in time away from work. For families in particular, it’s essential to get that balance before the stress impacts on the whole family. “It’s like the oxygen mask in the plane—you must fit it to yourself before helping your children,” says Emma Grey. “If you can’t ‘breathe’ because you have no time to yourself to rejuvenate, you will be no good to anyone—your employer or your family.” Another tip is to put yourself and family first and say no to extra commitments, like that after-hours meeting or weekend conference.
Work life balance
Top work-life balance tips Follow these tips, from work-life expert Emma Grey, to get some balance in your life: Reason to leave. Make a time you have to leave the practice. Whether it’s for family dinner by 7pm, or to coach your daughter’s soccer team at 5.30pm, a proper deadline will stop you overscheduling patients or catching up on paperwork after hours. “Having somewhere else to be sharpens your efficiency and helps you pull the plug on work.” Ignore the shiny things. “Turn your phone off and close email down for an hour if you really want to get to your after-hours activity on time,” says Grey.
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Declutter your diary. Block out chunks of time in your diary for no fixed purpose. “Experience the gift of breathing space,” says Grey. “Correctly estimate the time it will take to get from A to B and build in a buffer to move between commitments in a stress-free way.” Let things go. Don’t sweat the small stuff. “In the last 12 months, how much energy did you invest worrying about things that didn’t matter? Invest that energy positively, towards the things you want to achieve.” Lock in a holiday. Those who make time for holidays have usually booked them in advance. Make that booking now.
“Often, people focus on the sense that they’re letting people down, which is where the guilt creeps in,” says Grey. “Focus instead on what you’ve said ‘yes’ to and remember to value those priorities.” These were the kind of changes Dr Abdullah and her family made when they decided to cut down their workloads and get some more balance in their lives. New priorities and reduced hours were just the start. “Now, we open the practice for five days only,” Dr Abdullah says. “And we have two days off on the weekend with our family, cooking nice food at home and relaxing. We have a proper holiday once every year. My husband goes to see his family in Sumatra, and I take the children to see my family.” It’s also important to draw up boundaries between work and the rest of your life. “We have rules at home too, because we used to talk about work 24/7,” Dr Abdullah says. “Now, when we get home, we don’t talk about work in front of the children; we don’t bring the stress home. I will say, ‘Stop, don’t discuss this here’.” Dr Abdullah is also concentrating on making time for activities that bring her pleasure and relaxation, away from work and domestic duties. “I think we have to find ways to release the stress. I really like gardening now,” she says. “You have to do something else apart from clinical work, as it can just take over. It’s never-ending.”
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Your business Design
Article Vivienne Reiner
Odd spots Setting up your practice in a non-traditional location offers both design problems and opportunities—which can also be good for business
inding the right location for a practice is increasingly an issue as jobs and population growth results in a lack of available land. But dentists having to set up in nontraditional locations often find that a bit of forced creativity can be a good thing. Sydney-based dentist David Ekins took on the job of converting an expansive ArtDeco heritage listed home a number of years ago and has again been in the process of tackling council restrictions as he finishes an extension. Dr Ekins had been working under a month-by-month lease at Forestway Shopping Centre in Frenchs Forest when the high-profile home, commonly referred to as the “blue house” because of its external colouring, came onto the market. The house was ideally situated on a main intersection but Dr Ekins also considered a house next door, put up for sale at the same time. He went with the ocean-liner themed 1940s home— complete with wave shaped fence, round rooms and ample windows—because it cost less upfront and because he “liked the fact that it was a bit quirky”. His choice has been good for business; the curved rooms do away with the problem of two unused corners that practices tend to suffer from and there is ample natural light and ventilation, all resulting in an improved patient experience. But turning the protected home into a growing practice was not easy. The fact that the building is heritage listed, albeit at the lowest level as a building of significance in Warringah Shire, meant that design and paperwork costs blew out by up to 20 28 Bite
per cent as council rejections forced new approaches. The streetscape could not be altered significantly, so the car park at the front was only expanded marginally, the fence remained largely untouched and because a handrail was not allowed to be built with the intended wheelchair ramp, the path was instead made long and winding with a slight inclination. Replacing old windows with new ones provided other cost and access challenges, since round windows are no longer common. The
The curved rooms do away with the problem of unused corners that practices tend to suffer from and there is ample natural light and ventilation, all resulting in an improved patient experience. extension was also subject to restrictions: because the house structure could not be changed, the new part of the practice could not be extended into the original design. “The changes we made were not supposed to be visible from the street so it didn’t impact on the streetscape,” Dr Ekins explains. Wanting to create a space to work in in a highly patronised shopping arcade in Sydney's Strathfield provided different challenges for healthcare design and branding specialists Levitch Design Associates. Director Anne Levitch, who has a background in retail, well-understood the specific compli-
The compliance requirements of a dental surgery in a shopping mall led Levitch Design to create these striking sculptures for this Sydney surgery.
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Process drives efciency Elite’s all inclusive consult, plan, design and construct solution was invaluable. It meant we did not lose a single day of trading, we didn’t have to pay two lots of rent and saved a considerable sum of money. Dr Andrew Koranski, Quintessential Dental, Jimboomba.
Read the full case study of this project online at elitetout.com.au
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Making Dentists Smile Dr Helen Cornwell designed her own practice, including cabinetry, in a converted warehouse in Broadmeadow.
ance requirements of retail arcade environments, but the brief nonetheless necessitated some thinking outside the square in order to get the landlords interested. The shopfront had to be interactive with obvious signage and with an open view to the reception area and ample lighting. “We had to negotiate with the centre management and prove it was possible to give a dental practice a retail presence as they did not want a dentist there,” Levitch explains. The solution involved creating and erecting a three-metrehigh toothbrush model and an accompanying mirror. As well, all evidence of clinical work was concealed. Levitch says her team enjoyed the challenges of making the practice look appealing to potential patients and satisfying the high retail standards. “The retail aim is to make it a very exciting environment, to encourage people come to spend their money.”
different approach was needed in converting a dilapidated petrol station in the Brisbane suburb of Nundah. The clients took advantage of their move from a multidisciplinary medical centre by undertaking a rebrand at the same time, aiming at attracting a new patient with a focus on cosmetic work. The big pylon petrol station sign was transformed into signage. “I think the pressure’s always there to be creative in business,” Levitch says, “It’s just a matter of where the opportunities are.” For Helen Cornwell, a Broadmeadow-based pediatric dentist who works largely with special needs patients, moving into a pre-existing practice was not an option, since the specialist is one of a kind in the Newcastle suburb 80 minutes’ drive from Sydney. She came across a warehouse in a good location and penned the design herself, with the help of an access specialist who ensured the fit-out met regulations such as providing disabled toilets and access to rooms. Advantages of converting a warehouse include that the open space makes it easier to build in the rooms as desired. “We added a staircase and a mezzanine but we didn’t need to work around a lot of structure and features and supporting walls,” Dr Cornwall explains. It cost less than $500,000 for the re-fit, including three surgeries and two consulting rooms. In addition to practical considerations, Dr Cornwell had specific ideas about how her workplace should look, designing all the cabinetry herself and deciding on the placement of feature walls. “If it looks good, you’re happy to work in the environment,” she concludes.
Since 2002, Medifit has completed over 200 dental design and construction projects throughout Australia. We’re dental design and construction specialists, it’s all we do, and we make it our business to stay abreast of the latest technologies, equipment and compliance requirements. From renovations to complete ground up builds, we’ll help you to get the most out of your available space and transform your practice to work the way you do. And we’ll do it on time and on budget. For advice on making your practice work as hard as you do, contact us today for a no obligation consultation. Your patients won’t be the only ones smiling.
1300 728 133 www.medifit.com.au
4/07/11 1:40 PM
Practice Management Software product guide The total solution When Dr Ian Collins went shopping for new practice management software, he relied on word-of-mouth recommendations. So it was inevitable he’d buy dental4windows
aving a new associate in a practice is always a good excuse to change and update some of your old equipment. That was the case at Werribee Dental in September last year, when one of Dr Ian Collins’ associates retired and a new dentist came on board. “With the changes that were happening, we decided to upgrade our practice management software,” Dr Collins said. The system they were using was Lion, an older DOS system. “Before this we only had a basic accounting package, and kept our patient records on cards. But the practice is a very longstanding one—we had 24,000 cards to be transferred, and the ability to transfer all the existing data from our old system was a big selling point.” Dr Collins’ former associate took over Werribee Dental in 1976. Dr Collins joined in 1986. “And then we also had another part time dentist who has been here since 1981, and the new associate,” he says. “So two full time dentists, one part time.” Prior to joining the practice at Werribee, he had graduated with Honours in Dentistry (BDSc) from the University of Melbourne in 1982. He spent three years working in rural Victoria after that. He is an active member of the Australian Dental Association, and an active member of the International Association for Orthodontics. He maintains an active interest in all aspects of dentistry with special interests in orthodontics and cosmetic dentistry. The decision to update the practice’s practice management software was “to make life easier than anything else”, Dr Collins says. “We wanted to ensure that cards couldn’t be lost, and we also went to digital X-rays for ease of filing, so we wanted to fit in with that.” He and his associates asked other
dentists what they used, and they also had a look around at various trade shows. But word-of-mouth was the most important thing, and the only real choice was dental4Windows. Centaur software not only provided the system their colleagues used (and that one associate was familiar with)—there was also the offer of training, support and doing the data transfer from the older Lion system, which was a big help. Dental4windows continues to enjoy the benefits of the fundamental advantage as the first software designed by dentists for their own use. It continues to utilise the latest tools in computer technology to eliminate as many keystrokes and multiple window pop up changes as possible so you can access information in an instance. Based on feedback from over 5000 users, the design of the software is one that staff will immediately be able to use with no extensive training required to harness the power of each of the many features. From the very beginning the manufacturers, Centaur Software, had simplified the use of dental4windows by the development of an easy “workflow” design that allows you to view all
relevant patient details in a single glance. This is especially important in busy areas such as the front desk. There are also no unnecessary popup screens to slow you. What this means for users is faster processing of patient’s information to save time and improve efficiency. “In the end we decided to go with dental4windows because it was word of mouth that sold us,” says Dr Collins. “We also liked it because the digital imaging module, Media Suite, interfaces with the digital imaging system Centaur sold us, Durr VistaScan Mini, which uses the phosphor plates—they’re very comfortable for patients and the image quality is better than film.” He’s also impressed with the ease of transferring images to the chair-side TV. “Integration of my digital intra-oral camera was also very straightforward. I’ve got a 32-inch TV I can put X-rays on and show them to patients,” he explains. “We also get OPGs in digital form from radiographers, so I can show them on the TV as well.” Those OPG’s are stored, along with all referrals and other patient documents in the patient file within dental4windows in the system’s document manager.
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Practice Management Software product guide Carestream Dental’s PEARL
arestream Dental’s popular Practice Expert And Reporting Library (PEARL) module provides dentists several enhanced features that improve existing functionality and build on two-way mobile connection back to the office. With its ability to deliver real‐time information and constant communication with your office, the PEARL module provides a simple and powerful link between your PracticeWorks practice management software and your Apple iPhone® or BlackBerry® smartphone. Now, following the upgrade, users can: Create patient appointments or send cancellation requests; Block off scheduler time remotely; View or add patient clinical notes;
Examine clinical images associated with a patient record*; and Enjoy real, two-way interaction with the office– not just review stored files. Stay up to speed on your patients’ most relevant details using PEARL wherever you go and whenever you need to reconnect with the office. The helpful call list feature keeps track of your followup calls to patients. Or use PEARL to access a patient’s clinical profile. With this much information at your fingertips, you can be ready to communicate right away with a patient in need or a team member waiting on your feedback.
PEARL is also secure: no protected health information or related data is stored on a handheld device using PEARL. All of the data viewed via the PEARL module is hosted from your office’s server. The PEARL upgrade— now available!
• Simple yet Powerful and Mobile • Access information more easily with our re-designed reporting tools • Keep track of patient referrals with improved referral tracking • Stay on top of your day and in contact with your patients with the new KODAK PEARL Module
The educated choice. PracticeWorks software functions as the sophisticated, yet user-friendly hub of your practice: simplifying routine tasks, increasing efficiency, improving communication and managing your business and your bottom line.
Would you like to know more? www.carestreamdental.com Free Call: 1800 223 603 (Aust) 0800 508 744 (NZ) 34 Bite
Practice Management Software product guide
Praktika — Online Dental Software powered by the Internet
raktika is the first Australian Dental Practice Management System that runs over the Internet. It offers dental practitioners and practice managers unprecedented opportunities of secure remote data access and management by utilising the latest Cloud Computer Technologies. Praktika goes along with the 21st century trend of putting the information technology online. You can already book tickets and accommodation, read the newspapers and do your banking online. Now you can do the same with your Practice Management Software. Praktika has everything a modern Dental Practice Software package must have. It has a flexible Appointment Book, Periodontal and Restorative Charting, Patient’s
Files, Clinical Notes, Accounting and Billing, Estimates and Treatment Plans, SMS appointment confirmations, Imaging, Reports and Analysis tools, HICAPS integration, etc. Praktika goes even further and gives you something no other practice management software can. First of all, it relieves you from any IT worries – you don’t need to install anything, you can use any computer you like (Mac, Windows or even Linux). You can run it from work, home or any place with the Internet access. It is available 24/7 and so is the online support. Praktika does automatic backups for you and constantly monitors the health of your data. Some Praktika features are available as iPad and iPhone apps.
Praktika is a lot more affordable than the traditional packages. There is no upfront purchase cost and there are no individual licences. It means that you don’t have to pay a significant amount for your software and you can have as many users as you like for the same low monthly subscription fee. It makes Praktika great for start-up practices. Praktika is ideal for multi-location practices as it provides the real-time tools to administer the whole business. Mobile dentists also find Praktika indispensible – it is always with you. For more detailed info on Praktika and its features, visit www.praktika. com.au. Request your free, no obligation Test Drive and see how Praktika can make your operations more efficient.
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Practice Management Software product guide EXACT removes paper from dental practice Peninsula Dental Care goes paperless; practice management system minimises clicks and puts paper in its place – out of sight
he modern era of business computing promised to reduce paper, but created more. The problem was systems usability. As digitally stored information proliferated it became harder to render customised views of interrelated data, and printouts were a faster way to get what you needed. But that’s become a thing of the past as software makers refined interface design and systems navigation. Revelling in the simplicity of EXACT’s consolidated view of patient information, newlylaunched dental practice Peninsula Dental Care has streamlined practice management, introducing paper-based records management in a single system that gives reception and surgery a complete picture of patient activity.
views of consolidated patient information. “EXACT links up the entire practice. It’s organised and everything is in there – accounts, ACC, and dental benefits,” he said.
Proven performer for new practice Principal dentist and owner Oscar Chan was excited by the opportunity to start and grow newly opened dental practice Peninsular Dental Care, and software evaluation wasn’t necessary. An experienced EXACT user, Dr Chan knew exactly which practice management system was required to minimise paper handling and free-up himself and his nurse from manual administration. He said it was critical to be able to link both reception and surgery for synchronised
Practice management goes paperless At the heart of EXACT’s paper free practice management are two modules EXDOC and EXDOCe – together these modules orchestrate patient records, communications, and information views. Every patient interaction and communication is captured and managed under a patient’s file, providing an instant picture of both treatment and administrative contact, including letters, emails, appointments, and notes from telephone calls.
Local training and support All software, no matter how good, requires support. And while most vendors offer support of some kind, many pay lip service to local knowledge. Users want to know that systems support is familiar with both technology and the local operating environment. Remote support tools allow EXACT technicians to make changes on-screen, even taking control of a user’s mouse to execute commands. Training is similarly slick, with a twohour session backed up by a modestly priced monthly support plan.
Dr Chan accesses the same information and views from his surgery, adding patient charting information as he works, and generating quotes for extra treatment. Total recall Lost time is irrecoverable, which is why appointment books command more screen time than most other aspects of practice management software. Front desk staff must have
quick views of completed appointments, patients requiring follow-up, and histories of communication. Recall Manager puts a dashboard to the patient appointment book, adding automation that flags and executes patient reminders, minimising patient noshows. Click functionality allows receptionists to create patient, group, and family group emails and letters, to which any documents within EXACT can be attached. Better practice management Dr Chan said anything that reduces paperwork and file handling is good for practice management. “Physically filing things is crazy. We don’t want to be disappearing out the back searching for files. It’s all here at our fingertips. EXACT is the complete package.”
Benefits New practice minimises back-office distractions Reception and surgery patient information synchronised Patient bookings continue to grow
EXACT modules EXDOCe EXACT Recall What they do Centralised patient management and communication Streamlined patient reminders and recalls Why you need them Manage all patient communication within a single system Manage a paperless practice Automate patient recalls and reminders
SMS Reminders and Recalls Save 15 hours* monthly administration
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Smart Dentin Replacement
4 mm in a single cast. • • • •
Increments up to 4 mm without layering Excellent flow-like cavity adaptation1 Compatible with your current adhesive2 Up to 60% less polymerization stress3
24 month clinical trial results on SDR are in*. In summary: • No observations of recurrent caries • No failures attributable to SDR • Did not cause any post-operative sensitivity • No observations of interproximal wear after two years • No adverse effects on gingiva in contact with SDR • No adverse events reported throughout the trial
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For more information, contact your local DENTSPLY Territory Manager or visit: AU: www.dentsply.com.au • 1300 55 29 29 • NZ: www.dentsply.co.nz • 0800 DENTSPLY (33 68 77) In comparison to posterior and universal composites. Chemically compatible with methacrylate based adhesives and composites only. 3 Compared to conventional light-cured Polymerization. * Data on file. 1 2
Your tools Reviews
This month, get to grips with a rubber dam everyone can love; getting a grip on the best grips; and learn the magic anti-gagging properties of table salt
Tools of the trade
Aseptico rubber dam by Dr Tijana Fisher, The Dentist At 70 Pitt Street, Sydney, NSW When I was studying dentistry, we used rubber dams for every restoration. I stopped using them when I graduated and started working as an associate in private practice. About five years ago, shortly after I started my own practice, a patient who was worried about mercury contamination requested that I use a rubber dam. I haven’t looked back since that day. What’s good about it They provide me with a clean and dry field while giving direct access to the tooth. I am able to bond restorations without the fear of contamination by either saliva or bacteria. They are also a real help when removing amalgams or old restorations as they stop patients inhaling any removed material. I use them for every single filling. Some patients can find a rubber dam a little confronting and claustrophobic at first but even the most anxious patient ends up loving it. We have never received a single complaint about using rubber dams. What’s not so good It takes some time to properly fit but if your team knows what they are doing and you’ve practised it a few times, that time soon becomes negligible. You also need a collection of different shaped rubber dam clamps on hand because of the wide variety of tooth shapes. Very occasionally I find that none of the clamps will fit a particular tooth and the patient has to go without a rubber dam. It’s a good idea to stock up on clamps. Where did you get it Dentavision.
Danville Mega Grip Forceps by Dr Robert South, West Lakes Dental, West Lakes, SA About 18 months ago, I was attending a Raymond Bertolotti course in Sydney and first came across the Mega Grip Forceps. They are designed for removing matrix bands but work equally well in removing anything that is wedged between the teeth. What’s good about them They are shaped a bit like lower molar forceps but have a very ‘grippy’ texture to them. It is this cross-cut texture which helps to grip the smooth matrix band. One of the problems with removing matrix bands, even when using diamond-tipped tweezers, is that it’s difficult to get enough traction to grip the band and pull it out. If you have a really tight contact which, of course, you want, the resin system can partially bond to the metal on the matrix and make it extremely hard to remove. Even with these forceps, it can take a bit of wiggling but it’s far superior to anything else I have ever used. What’s not so good The only disadvantage is that the jaws should be slightly longer. There are times when it can be a little bit difficult to get into the area and get a grip on the matrix. Apart from that, it’s a marvellous little tool. All the dentists have a set of them in our practice. Where did you get it Amalgadent. Bite 39
Your tools Reviews
Saxa salt by Dr Rob Donaldson, Dental Care Carine, Duncraig, WA I picked this trick up about eight years ago from a dental nurse who had worked for another dentist. When taking X-rays or impressions, there’s a certain percentage of people who have a very powerful gag reflex. By sprinkling a little salt on their tongue just prior to introducing anything into their mouth, it successfully inhibits that gag reflex. What’s good about it I don’t know why this works. It may have something to do with sensory input overload or the cranial nerves. It might even be a psychological comfort thing or a bit of a placebo effect. It would probably make a good topic for a thesis. However there’s no doubt that it makes it a lot more comfortable for patients to tolerate a bitewing radiograph or a lower and upper impression. I don’t use it with all patients, just those who start to heave as soon as you put something in their mouth. I tell them to imagine they’re having a margarita. While it’s not 100 per cent effective in 100 per cent of cases, it works often enough for me to keep using it. The patients who have a gag reflex problem are very
grateful that such a simple thing can offer them relief so quickly. What’s not so good Nothing. It’s not a gimmick—it works. And most people have salt sitting in their kitchen. Where do you get it Your local supermarket.
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Traxodent Hemodent paste by Dr Dianne Haddad-Ferraro, My Dental On Prospect, Prospect, SA During crown preparations, I’ve been using Traxodent in substitution of the secondary retraction cord. I still use the primary retraction cord but then syringe the paste around the gumline. It’s much more comfortable for the patient than having two cords placed. What’s good about it Traxodent has the added component of haemostasis along with its retraction feature. In some situations it’s possible to use the paste completely in place of retraction cords. It’s very useful when there is a cavity under the gumline and you need some haemostasis. By syringing the paste onto the gum, leaving it on for a few minutes then washing it off, it stops the gum bleeding into the cavity. It also aids the healing process after the procedure. From a patient comfort perspective, the paste is great. It’s easy for the clinician to place as it has an inbuilt syringe tip that provides excellent reach. I’ve tried similar products but never had a great deal of success with them. I’ve been very happy with Traxodent—it’s an easy product to use and it decreases patient discomfort.
What’s not so good The syringe tip is very small but it can still be a bit bulky because you are trying to use it around the sulcus. In some situations you don’t always feel like your getting the paste where it needs to be. It would be better if the syringe tip was finer but the consistency of the material probably means that it can’t be changed. The paste also has an unpleasant taste. It would be great if they could improve the flavour. Where did you get it Gunz Dental.
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“Every year we gather all the dentists on the Sunshine Coast and have an end-of-financial year bash. There are prizes not only for the fastest dentist but also for the fastest staff member, dental nurse and team entry. What surprised me a little was how good are a lot of the dental nurses. There are dental nurses up among the top racers. A little less surprising was that some dentists were completely hopeless. They enjoyed it but it was like they were starring in Driving Miss Daisy. I did learn to be wary of people who turn up with their own helmets! “Dentistry can be an insular profession so it’s nice to have a social event where the locals can all catch up and have some fun. We’re thinking of making this an annual event as a way to bring our local dental community together.
Photography: Mike Duffy
The ‘Fastest Dentist on the Sunshine Coast’ is a go-kart race where dentists and their staff get to let their inner rev-head off the leash. Perry Johnson, the business manager who runs my practice, came up with the idea for the race and I helped him organise it. We’ve had 120 people race across three rounds so far. When the competitors first arrived, everyone was joking and laughing until it started getting near to race time— then it all became very serious. People were watching to see which kart appeared to be the fastest so they could nab it for themselves. “During one heat, there was a bit of rain and the karts were spinning out all over the place. The general consensus seemed to be that when you’re racing, just put your foot flat to the floor and go as fast as you can. There wasn’t a lot of braking.
Maxillofacial & Implant Centre, Birtinya, QLD
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Source - 2009 Professional Tracking Study (data on file)
In Vitro SEM photograph of dentine surface after application.
Air blast sensitivity score
3 In Vitro SEM photograph of untreated dentine surface.
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